Provider Demographics
NPI:1861613069
Name:JOSE, CARRIE (PT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53B GREEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-3735
Mailing Address - Country:US
Mailing Address - Phone:603-380-7902
Mailing Address - Fax:
Practice Address - Street 1:53B GREEN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-3735
Practice Address - Country:US
Practice Address - Phone:603-380-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
DCPT870943225100000X
NH38952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16152OtherPT LICENSE
NH3895OtherPT LICENSE
NH3895OtherPT LICENSE
NH3895OtherPT LICENSE